Provider Demographics
NPI:1336450410
Name:STEELE, BRIAN MATHEW (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:MATHEW
Last Name:STEELE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 W US HIGHWAY 82
Mailing Address - Street 2:
Mailing Address - City:NEW BOSTON
Mailing Address - State:TX
Mailing Address - Zip Code:75570-2804
Mailing Address - Country:US
Mailing Address - Phone:903-628-5437
Mailing Address - Fax:903-628-0270
Practice Address - Street 1:112 W US HIGHWAY 82
Practice Address - Street 2:
Practice Address - City:NEW BOSTON
Practice Address - State:TX
Practice Address - Zip Code:75570-2804
Practice Address - Country:US
Practice Address - Phone:903-628-5437
Practice Address - Fax:903-628-0270
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-23
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX25576122300000X, 1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX338482801Medicaid
TX338482803Medicaid